Medical Bill Review

Over 90% of all hospital bills contain errors that cost you money. MedReview’s Hospital and Physician Bill Audit Service helps health plans and employers reduce costly billing errors and helps them take control of costs by revealing duplicate charges, incorrectly calculated charges and charges for services never rendered.

Through our pre-payment audit process, we identify auditable claims and then verify that billed services were ordered by the physician, rendered to the patient, and charged at appropriate rates.

Our system combines the experience of highly trained nurse reviewers, coding specialists and an on-site Medical Director to review treatment protocols. Our state-of-the-art medical billing software allow us to achieve lower claims costs on both hospital and physician bills.



SERVICES PROVIDED

• Prospective Audits - Auditing of all large hospital and questionable physician bills prior to payment.

• Hospital Bill Audits - Review large hospital bills for overpayment and other erroneous charges.

• Physician Bill Audits - Review physician bills for overpayment and other erroneous charges.

• Workers Compensation Claim Audits - Review workers compensation claims for overpayment.


THE PROCESS

Step 1: Financial Review – Line by line comparisons of the supporting hospital claim itemization are the only valid way to adjust for incorrect billing practices and to supply corrected standard fees for ‘usual and customary’ areas of treatment, supplies, etc. MedReview performs the audit of the hospital or physician’s bill to determine if there were incorrect charges.

Step 2: Clinical Review – MedReview’s trained medical staff and physicians provide a thorough review of claims reaching a certain dollar threshold or other criteria as defined by you. This includes a review of the medical records and treatment protocols to ensure that you are only paying for services that were actually rendered and for services that are billed appropriately.


MedReview relies on coding guidelines published by the American Medical Association and CMS (Center for Medicare and Medicaid) using industry standards for ‘usual and customary’ charges.